Forms

General

Office Policy
Due to the extreme volume of patients and patients’ needs, the following policies have become necessary to help us better serve all our patients. Please click 'download' to see and/or print our Office Policy. 


Notice of HIPAA Privacy
We understand that your medical information is private and confidential. Please click 'download' to see and/or print our Notice of HIPPA Privacy.
HIPAA Signed Form


Patient Registration Form
This file is our Patient Demographic Information Sheet and is required for new patients. Please click 'download' to see and/or download the file.


First Visit Form
This file is our First Visit Patient form and will aid you and your doctor if filled out before your first visit. Please click 'download' to see and/or download the file.


Release of Medical Records
This file is a request for a release of medical records. Please click 'download' to see and/or download the file.
Meaningful Use Requirements

Self Monitoring Blood Glucose Diary

Oscar T. Ortiz, MD
Please click the 'download' button, and then print out the document. This specific document is for patients of Oscar T. Ortiz, MD.


Ronald B. Villanueva, MD
Please click the 'download' button, and then print out the document. This specific document is for patients of Ronald B. Villanueva, MD.


Leslie Taguba-Madrid, MD
Please click the 'download' button, and then print out the document. This specific document is for patients of Leslie Taguba-Madrid.